1407026446 NPI number — ROSEMARY JACOBS MSN FNP BC

Table of content: ROSEMARY JACOBS MSN FNP BC (NPI 1407026446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407026446 NPI number — ROSEMARY JACOBS MSN FNP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407026446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8510 WILKINSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MILLINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38053-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-872-3114
Provider Business Mailing Address Fax Number:
901-872-3116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8510 WILKINSVILLE RD
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
MILLINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-872-3114
Provider Business Practice Location Address Fax Number:
901-872-3114
Provider Enumeration Date:
03/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  13302 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1700227436 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1513105 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com